OPTIMAL

op·ti·mal
The most desirable; most effective; best place to be.

Never has a word like optimal had more meaning than for hypothyroid patients, no matter the cause of their hypothyroidism.

Why being optimal isn’t just about feeling good

We, as hypothyroid patients, learned the hard way over the years that we will start feeling good on doses that aren’t yet optimal. Thus, many think they have arrived and stay with a non-optimal dose.

But it will eventually backfire with an unhappy return of symptoms, sooner or later. Why? Non-optimal doses aren’t going to be meeting all our biological or energy needs over time. Thus, hypothyroid symptoms will creep back up with a vengeance.

So what then is “optimal”?

  • WHEN ON A TREATMENT THAT PROVIDES BOTH T4 and T3 (a “working” NDT or synthetic T4 with synthetic T3): Gaining on nearly two decades of our observations and experiences as revealed by STTM, optimal puts the Free T3 (FT3) at the top part of the range, and a Free T4 (FT4) around midrange. Both.
  • WHEN ON A TREATMENT WITH T3-ONLY: Optimal has always seemed to get the free T3 at the top of the range, and for some, slightly over range. Free T4 will naturally be low on T3-only, and it’s never been a problem other than you won’t be converting to T3 behind the scenes.
Don’t go backwards.

So tell me again: why does it backfire if we aren’t optimal with our FT3 (and FT4 if it’s in our treatment, too)?

  1. When we are on these thyroid meds (and if we still have a thyroid), they are going to suppress whatever remaining release of thyroid hormones we still had, even if that release was poor. So to the degree we suppress, we need to replace in an amount that meets our daily, weekly and monthly needs. If we don’t replace enough, it eventually backfires.
  2. All your organs need the right amount of T3 to function well. Without the right amount, problems can increase like depression, brain fog, concentration issues, cortisol issues, joint pain, liver stress as revealed by liver labs, heart issues, dry skin, hair loss..on and on and on.
  3. Certain life circumstances will need the right amount of free T3 to help you function better during stress or demands. So if we aren’t optimal, life can demand more than you may be giving yourself.

But I’ve had problems when I tried to raise and get my FT3 optimal..

Feeling hyper, irritability or impatience with others, shakiness, high heartrate, palps, anxiety, shakiness, etc. Those are about having a cortisol problem which needs discovery and treatment. Cortisol problems are from being on nothing but T4, or underdosing yourself. Cortisol problems ALSO cause a high free T3 and a low free T4 when you are on T4/T3 or a working NDT, called pooling.

Just never getting there, or having a rising RT3 (reverse T3) lab results, or feeling more hypo. If you are raising with inadequate iron levels or inflammation, RT3 will go up. If RT3 goes up, you will feel more hypo. If you are still using NDT’s that do NOT work well anymore, you can also never get there: Naturethroid, WP Thyroid, NP Thyroid and sometimes Erfa in Canada. THEY DO NOT WORK LIKE THEY USED TO AND ARE NOT WORTH BEING ON IN MOST CASES. Armour is the only one that might work. Read THIS as to what went wrong with NDT.

Being made to worry about the very low TSH as I try to head towards optimal.…thus I stop the raises. As much as we like having a relationship with the doctor, this is one area they are wrong and backwards about. It’s natural for the TSH to go very low, and it does NOT cause bone or heart problems. They are confusing it with Graves’ disease which causes causes the latter with a low TSH. Read about the TSH issue.

If the prescription NDT’s have changed for the worse, what should I be on to get optimal (with the right amount of iron and cortisol)?

  • Synthetic T4 with Synthetic T3
  • T3-only, multi-dosed.
  • Compounded NDT (at the time of this writing, some compounders have a source of porcine powder which still works; others are using porcine powder which has stopped working)
  • Armour NDT may work to get get optimal (at the time of this writing). If you have problems, others are adding T3 to it to get optimal.
  • Over-the-counter NDT’s (But beware…there are many instances over the years where a particular batch brought back hypo symptoms or odd labs. That’s why patients keep a supply of T3 handy)
  • Thai brands like Thyroid-S (at the time of this writing)

Do I test my free’s within a few days after a raise of my thyroid meds?

If we are on both T4 and T3, it takes a few weeks to see the conversion results of T4 to T3. So only after a few weeks do we test. But if on nothing but T3, we can test the free T3 in about a week.

Do I test my free’s after a dose of thyroid meds?

No, no, no!! That is because there is a slight rise of T4 after taking meds, and a definite high rise of T3 after taking T3-containing meds. We don’t want to test those temporary rises. We want to know what we are hanging onto. So we take our meds as usual one day, then test the next morning BEFORE taking our thyroid meds for the day. (If on a T3-containing treatment, best to take it twice, or three times a day, before the next day morning test)

I have an optimal Free T3 (top of range) or higher, but Free T4 is really low?

  1. If this is occurring when on both T4 and T3, that can be about pooling and reveals a cortisol problem. Read this.
  2. This can also happen if we are on a larger amount of T3 meds and a smaller amount of T4 meds. No biggie.
  3. If this is occurring and you are only on T3-only, that is very normal if you feel great. If you don’t feel great, it’s also about pooling.

Can I get optimal on just T4-only like Levo or Synthroid?

Hardly ever. And even when someone gets close, it’s not uncommon to still see problems, sooner or later. Sadly, there are too many life situations that can block the conversion of T4 to T3. https://stopthethyroidmadness.com/t4-only-meds-dont-work

Can I get optimal on a low dose of T3/low dose of a working NDT, with a lot of added T4.

Hardly ever. It’s puts us right back to depending mostly on conversion of T4 to T3.

I’m seeing my TSH go below range…

Even on non-optimal doses of a treatment with both T4 and T3, or T3-only, it’s typical and expected to see a TSH lab result go below the range. And it will continue being low as we make our way up to an optimal dose.

Sadly, you have to stand firm against doctors who wrongly freak out about that normal low TSH with T3 in your treatment. Our low TSH is not the same as the low TSH seen with Graves’ disease, the hyperthyroid side of the coin that doctors confuse it with. Our low TSH when optimal with the frees does NOT cause bone loss or heart disease–it’s uncontrolled Graves’ disease that can do that, or still being underdosed, or having an iron or cortisol problem keeping us underdosed.

To the contrary, when we are nearing optimal with our free T3 and free T4, or right at it, patients have reported improved bone and heart health!!

<—THIS is your book, full of important patient-to-patient information and all the ways patients got well. Includes updates and other good information based on years of patient wisdom. Throughout, the updated revision STTM book mentions optimal as well as more information that is crucial to getting fully well again. READ MORE HERE: https://laughinggrapepublishing.com

Have autoimmune Hashimoto’s disease? —-> This is also your book with important patient-to-patient information on how to put those antibodies into remission. As a companion book to the above, Hashimoto’s: Taming the Beast has been put together in an easier to read layout–no excessively long chapters, no chit-chat or long stories. READ MORE HERE: https://laughinggrapepublishing.com

Don’t discount these life-changing books just because there is a website. There is important info in these books that won’t be covered the same way on the site. Plus, patients report getting even more from books where they can highlight, underline or bookmark the pages. One place to order is right here.

One place to order is right here.

Important note: STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.